| NPI | 1376724609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2012-06-05 |